Soru

A primigravid patient at 39 weeks and 5 days of gestation is admitted to the labor and delivery ward in active labor. She has no significant past medical history and her prenatal course was unremarkable. Pelvic examination reveals a cervix that is 7 cm dilated and 100% effaced, with the fetal vertex at 0 station. Clear amniotic fluid is noted following spontaneous membrane rupture three hours ago. Uterine contractions are occurring every 3 minutes. The continuous fetal heart rate monitor shows a baseline of 145/min with moderate variability. During the last 40 minutes, there are recurrent, abrupt decreases in the fetal heart rate to 85/min that last for approximately 45 seconds. The onset, depth, and duration of these decelerations vary from one contraction to the next, often without a consistent relationship to the peak of the contraction. Initial resuscitative measures, including maternal repositioning to the left lateral decubitus position and administration of an intravenous fluid bolus, have been performed. Despite these interventions, the fetal heart rate pattern remains unchanged. Which of the following is the most appropriate next step in management?